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MARKETWATCH
Costs Of Severely Ill Members And Specialty Medication Use In A Commercially Insured Population
Vincent J. Willey,
Michael F. Pollack,
Wayne M. Lednar,
William N. Yang,
Charles Kennedy and
Grant Lawless
This study examines the overall profile and costs associated with severely ill commercially insured people. We found severely ill members to have the highest costs, from both the insurer and member perspective. Even for the most costly members where specialty medication use was highest, biologics represented less than one-third of the pharmacy spending and 6.6 percent of overall spending. Out-of-pocket spending rose dramatically when medications were paid for under the pharmacy benefit rather than the medical benefit. The advantages of paying for specialty medications under the pharmacy benefit should be evaluated in conjunction with the potential consequences of increased out-of-pocket burden.
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T. H. Lee and E. J. Emanuel
Tier 4 Drugs and the Fraying of the Social Compact
N. Engl. J. Med.,
July 24, 2008;
359(4):
333 - 335.
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